- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | 26 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $66.07 / $151.36
| Professional | | $44.67 | $66.07 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $89.13
| Professional | 26 | $23.99 | $33.11 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $16.60 / $38.02 / $61.66
| Professional | TC | $16.60 | $38.02 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $112.20 / $117.49
| Professional | | $89.13 | $112.20 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $48.98 / $51.29
| Professional | 26 | $38.90 | $48.98 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $53.70 / $63.10 / $66.07
| Professional | TC | $53.70 | $63.10 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $131.83
| Professional | | $54.95 | $85.11 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $54.95
| Professional | 26 | $25.70 | $39.81 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $41.69 / $61.66
| Professional | TC | $19.50 | $41.69 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | 26 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $97.72 / $120.23
| Professional | | $63.10 | $97.72 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $41.69 / $52.48
| Professional | 26 | $28.18 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $34.67 / $56.23 / $69.18
| Professional | TC | $34.67 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Facility | 26 | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $89.13 / $120.23
| Professional | | $75.86 | $89.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $56.23
| Professional | 26 | $31.62 | $37.15 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $70.79
| Professional | TC | $44.67 | $52.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $64.57 / $102.33
| Professional | | $56.23 | $64.57 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $23.99 / $24.55 / $44.67
| Professional | 26 | $23.99 | $24.55 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $29.51 / $31.62 / $54.95
| Professional | TC | $29.51 | $31.62 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $64.57 / $89.13
| Professional | | $45.71 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $45.71
| Professional | 26 | $26.30 | $36.31 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $17.78 / $26.30 / $45.71
| Professional | TC | $17.78 | $26.30 | $45.71 |